BACKGROUND: Limited published data exist that address the incidence and outcomes of patients with complete pancreatic-duct disruption. OBJECTIVE: Report on a single-center experience with this entity that emphasizes the feasibility of endoscopic therapy and long-term outcomes. DESIGN: Retrospective analysis. SETTING: Tertiary-care medical center (Portland, Maine). PATIENTS: A total of 189 patients with pancreatic-fluid collections and/or pancreatic fistulas were retrospectively evaluated for the presence of a disconnected pancreatic tail. Patients meeting the definition of disconnected pancreatic tail syndrome (DPTS) with a minimum of 6 months' follow-up were analyzed. RESULTS: Thirty of 189 patients (16%) met criteria for DPTS. Thirty-six drainage procedures were performed on 29 patients (mean 1.2 procedures per patient). In 22 of 29 patients (76%), the initial drainage procedure was successful. However, recurrent fluid collection(s) developed in 11 of 22 patients (50%) and was seen in those treated surgically and endoscopically. Disruption in the tail (n = 3) was uncommon but invariably required no surgical intervention. The median follow-up was 38 months (range 3-94 months). Diabetes mellitus developed in 16 of 30 patients (53%); 15 of 30 patients (50%) had left-sided portal hypertension; 16 of 30 patients (53%) continue in active medical or surgical follow-up for recurrent symptoms attributable to the disconnected pancreatic tail. CONCLUSIONS: Of patients with a pancreatic-fluid collection and/or fistula, 16% will also have a disconnected pancreatic tail. Endoscopic and surgical drainage techniques are typically initially successful, but both suffer from a high rate of recurrence in the setting of DPTS. The majority of patients will require long-term follow-up because of complications and/or ongoing symptoms.
BACKGROUND: Limited published data exist that address the incidence and outcomes of patients with complete pancreatic-duct disruption. OBJECTIVE: Report on a single-center experience with this entity that emphasizes the feasibility of endoscopic therapy and long-term outcomes. DESIGN: Retrospective analysis. SETTING: Tertiary-care medical center (Portland, Maine). PATIENTS: A total of 189 patients with pancreatic-fluid collections and/or pancreatic fistulas were retrospectively evaluated for the presence of a disconnected pancreatic tail. Patients meeting the definition of disconnected pancreatic tail syndrome (DPTS) with a minimum of 6 months' follow-up were analyzed. RESULTS: Thirty of 189 patients (16%) met criteria for DPTS. Thirty-six drainage procedures were performed on 29 patients (mean 1.2 procedures per patient). In 22 of 29 patients (76%), the initial drainage procedure was successful. However, recurrent fluid collection(s) developed in 11 of 22 patients (50%) and was seen in those treated surgically and endoscopically. Disruption in the tail (n = 3) was uncommon but invariably required no surgical intervention. The median follow-up was 38 months (range 3-94 months). Diabetes mellitus developed in 16 of 30 patients (53%); 15 of 30 patients (50%) had left-sided portal hypertension; 16 of 30 patients (53%) continue in active medical or surgical follow-up for recurrent symptoms attributable to the disconnected pancreatic tail. CONCLUSIONS: Of patients with a pancreatic-fluid collection and/or fistula, 16% will also have a disconnected pancreatic tail. Endoscopic and surgical drainage techniques are typically initially successful, but both suffer from a high rate of recurrence in the setting of DPTS. The majority of patients will require long-term follow-up because of complications and/or ongoing symptoms.
Authors: James R Butler; George J Eckert; Nicholas J Zyromski; Michael J Leonardi; Keith D Lillemoe; Thomas J Howard Journal: HPB (Oxford) Date: 2011-10-12 Impact factor: 3.647
Authors: Vikrom K Dhar; Jeffrey M Sutton; Brent T Xia; Nick C Levinsky; Gregory C Wilson; Milton Smith; Kyuran A Choe; Jonathan Moulton; Doan Vu; Ross Ristagno; Jeffrey J Sussman; Michael J Edwards; Daniel E Abbott; Syed A Ahmad Journal: J Gastrointest Surg Date: 2017-04-10 Impact factor: 3.452